Browsing by Author "Iskesen, I"
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Item Superior mesenteric artery branch - jejunal artery aneurysmKurdal, AT; Cerrahoglu, M; Iskesen, I; Sirin, HVisceral artery aneurysm (VAA) is a relatively uncommon disorder and it shows some vague symptoms. Therefore, the clinical diagnosis is difficult and these aneurysms are discovered and diagnosed only after rupture in many cases. This case report describes the history of a woman who had a superior mesenteric artery (SMA) branch aneurysm. A 62-year-old woman presented with fatigue and moderate to severe epigastric and mid-back pain. A computed tomography of the abdomen and pelvis demonstrated a partially thrombosed aneurysm (38x40 mm) rising from the jejunal branch of the SMA. The aneurysm which contains mural thrombus is resected, and a saphenous vein graft interposition is performed between the ends of the same jejuno-jejunal artery. The patient's recovery was unremarkable, and she was discharged on postoperative day 7. Rapid diagnosis, localization, and surgical or endovascular interventions are necessary to avoid devastating consequences in VAAs. Saphenous vein graft interposition is a good choice for surgical intervention for patients not suitable for endovascular treatment. (C) 2010 Published by European Association for Cardio-Thoracic Surgery. All rights reserved.Item Urgent Right Coronary Artery Bypass Surgery Due to Stent Distortion by a Stitched Guidewire.Senarslan, DA; Yildirim, F; Özbakkaloglu, A; Kurdal, AT; Bayram, B; Damar, A; Iskesen, I; Cerrahoglu, M; Tetik, ÖItem Trimetazidine reduces oxidative stress in cardiac surgeryIskesen, I; Saribulbul, O; Cerrahoglu, M; Var, A; Nazli, Y; Sirin, HBackground Trimetazidine is an anti-ischemic agent that is used to treat angina and it has cardioprotective effects without inducing any significant hemodynamic changes. It inhibits the long-chain mitochondrial 3-ketoacyl coenzyme A thiolase enzyme in the myocyte and can improve cardiac mitochondrial metabolism, as well as scavenge free radicals. The aim of this double-blind prospective randomized study was to investigate the effect of preoperative use of trimetazidine on the reduction of oxidative stress during coronary artery bypass grafting (CABG) under cardiopulmonary bypass (CPB). Methods and Results The study group (group T) and the control group (group C) each comprised 12 patients. Pretreatment began 2 weeks before CABG with trimetazidine (60 mg/day po); the control group did not receive any medication. Serial blood samples were collected before and after CPB for measurement of the serum concentrations of these major endogenous antioxidant enzyme systems, which are markers for oxidative degradation of the cellular membranes; postoperative levels were significantly different between the groups (p < 0.05). There were no significant difference in hemodynamic values. Conclusion The findings suggest that Pretreatment with trimetazidine alleviates malondialdehyde production and preserves endogenous antioxidant capacity during CABG with CPB and cardioplegic arrest.Item Calcium dobesilate reduces oxidative stress in cardiac surgeryCerrahoglu, M; Kurdal, AT; Iskesen, I; Onur, E; Sirin, HAim. Calcium dobesilate (CD) is a synthetic benzene sulfonate derivative and an angioprotective agent used orally. It can be used in patients who have diabetic retinopathy or chronic venous insufficiency. The aim of this study was to investigate the effect of CD on the reduction of oxidative stress during coronary artery bypass graft operations on cardiopulmonary bypass. Methods. A double-blind prospective randomized study was carried out on 30 patients who underwent coronary artery bypass operations. The control and study groups were composed of 15 patients each. Pretreatment with CD started two weeks before. the operation. Serial blood samples for superoxide dismutase, glutathione peroxidase were collected for the serum concentration measurements of the major endogenous, antioxidant enzyme systems and malondialdehyde for scavenging capacity. Results. After the release of cross clamp levels of superoxide dismutase and glutathione peroxidase. they were significantly higher in the study group than in the control group (P<0.05). Malondialdehyde levels in the study group were significantly lower than those of the control group (P<0.05). The cardiac function after aortic declamping was affected by CD, indicating contribution of CD to myocardial injury from ischemia/reperfusion. Conclusion The study suggests that pretreatment with CD alleviates malondialdehyde production and preserves endogenous antioxidant capacity during cardiopulmonary bypass and cardioplegic arrest.Item Ultrasound-guided catheter-directed foam sclerotherapy for great saphenous veinKurdal, AT; Yildirim, F; Ozbakkaloglu, A; Iskesen, I; Tetik, OAim. The problem of varicose veins in the lower leg is a common disease and associated with long-term morbidity. It has usually been treated using high ligation with stripping and endovenous ablation surgery of the great saphenous vein. The aim of this paper is to report our own series of patients treated by ultrasound guided catheter directed foam sclerotherapy for the chemical ablation of great saphenous vein. Methods. The study involved 108 legs with symptomatic varicose veins (C2-4) secondary to great saphenous vein insufficiency. The great saphenous vein was accessed at knee level. With the method of Tessari sclerosant foam was made (2 mL 3% polidocanol and 8 mL air) and delivered along the great saphenous vein while the catheter was withdrawn. At two and fifty two weeks after treatment the patients were evaluated. Results. Catheter-directed foam sclerotheraphy was successfully performed in all of the patients. Venous Clinic Severity Score was reduced significantly (P<0.05). Eighty nine percent of the GSV were completely occluded, 4% were partly occluded and 7% were recanalized. No serious side-effects occurred. Conclusion. Catheter-directed foam sclerotheraphy is a safe, simple and minimally invasive procedure. Patient satisfaction was good and the occlusion rate is promising after a single treatment.Item Preoperative Oral Pentoxifylline for Management of Cytokine Reactions in Cardiac SurgeryIskesen, I; Kurdal, AT; Kahraman, N; Cerrahoglu, M; Sirin, BHBackground: Cardiopulmonary bypass may lead to many inflammatory responses that may cause myocardial dysfunction after open heart surgery. We aimed to investigate the effect of preoperative pentoxifylline treatment to reduce the occurrence of cardiopulmonary bypass-induced inflammatory response. Methods: In a prospective, randomized study, 40 patients undergoing coronary artery bypass graft surgery received either pentoxifylline (study group, n = 21) or not (control group, n = 19). Pretreatment with pentoxifylline (800 mg/day orally) was started 5 days before the operation. Blood samples for measurements of tumor necrosis factor (TNF)-alpha, interleukin (IL)-6, IL-8 from the arterial line, and venous blood samples for creatine kinase (CK) and CK isoenzyme fraction MB (CK-MB) were taken in both groups at 5 different time points. Hemodynamic parameters were measured with the thermodilution technique. Results: TNF-alpha, IL-6, and IL-8 plasma levels increased in both groups after cardiopulmonary bypass, with a greater increase in the control group (P < .05). There were no significant differences between the groups for the values of CK-MB and hemodynamic parameters. Conclusions: We conclude that pretreatment with oral pentoxifylline before cardiac surgery inhibits proinflammatory cytokine release caused by cardiopulmonary bypass and has some beneficial effects in protecting the myocardium during the cardioplegic arrest period in open-heart surgery, without affecting postoperative hemodynamics.Item Opening the cardiac chambers does not make any difference in P300 measurementIskesen, I; Yilmaz, H; Yildirim, F; Selcuki, DObjective. Cognitive brain dysfunction after open heart surgery is a serious complication caused by cardiopulmonary bypass (CPB). The presence of gaseous and/or particulate emboli in the CPB circuit and cerebral hypoperfusion may be the causes of neurologic problems after cardiac operations. Methods. In this prospective study we examined 42 consecutive cardiac surgery patients ( 24 mitral valve replacement [MVR] and 18 coronary artery bypass grafting [CABG] patients). In addition to determination of clinical measurements, cognitive brain function was measured objectively by P300 auditory-evoked potentials before operation, at day 7, and at 4-month follow-up. Electroencephalographic evaluations were also performed. Results. In preoperative measures there was no difference between the groups ( peak latencies in the MVR group were 324 +/- 8 milliseconds; CABG group, 318 +/- 6 milliseconds; P >.05). At day 7, cognitive P300 auditory-evoked potentials were significantly impaired ( prolonged) in both groups compared to preoperative values ( MVR group, 347 +/- 7 milliseconds; CABG group, 342 +/- 7 milliseconds; P <.05). P300 measurements almost returned to normal at 4-month follow-up ( MVR group, 331 +/- 6 milliseconds; CABG group, 319 +/- 8 milliseconds; P >.05 compared to preoperative values). One week and 4 months after surgery no difference between the 2 groups could be found ( P >.05). Conclusion. Postoperative patients had prolonged P300 values according to the preoperative measurements and we have not found any difference between the groups whether cardiac chambers were opened or not.Item N-terminal ProBNP levels can predict cardiac failure after cardiac surgeryCerrahoglu, M; Iskesen, I; Tekin, C; Onur, E; Yildirim, F; Sirin, BHBackground The aim of this study was to evaluate, the relationship between the preoperative N-terminal proB-type natriuretic peptide (NT-proBNP) level and the need for the inotropic support in the early postoperative period of patients undergoing coronary artery bypass graft surgery. Methods and Results The patients were divided into 2 groups: NT-proBNP level < 220pg/ml (group A, n=26) or > 220 pg/ml (group B, n=26). The normal value for NT-proBNP level was accepted as < 220 pg/ml. The cardiac output was measured on arrival in intensive care and at the 16(th) hour. The groups were compared with respect to early postoperative hemodynamic measurements, urinary output, use of inotropic agents and requirement for additional cardiac-assist devices. Left ventricular ejection fraction, cardiac output and cardiac index were lower in group B and inotropic agents were used for a longer period of time and at higher doses in this group (p < 0.05). Conclusion Measurement of the NT-proBNP level in the period before cardiac surgery can indicate the postoperative prognosis of the patient and may be a predictor of the need for postoperative inotropic treatment.Item Follow-up with objective and subjective tests of the sleep characteristics of patients after cardiac surgeryYilmaz, H; Iskesen, IBackground The purpose of this study was to investigate the changes in sleep characteristics in patients who underwent coronary artery bypass grafting (CABG) surgery, using both subjective and objective tests in the early (preoperative) and late (postoperative) periods. Methods and Results Forty-five patients who underwent CABG and did not previously have any sleep disturbance were evaluated by subjective and objective sleep parameters during a consecutive 3-5-day preoperative examination, during a consecutive 5-8-day period in the 1(st) postoperative week, and during consecutive 5-8-day periods in the Is' and 2(nd) postoperative months. The Pittsburgh Index and Epworth Sleepiness Scale values, sleep latency, napping episodes, total napping period, duration of wakefulness after sleep onset and fragmentation index values were significantly increased; however, Maintenance of Wakefulness Test lengths, total sleep time and sleep efficiency were significantly decreased in the Is' postoperative week. All of these were the same in the Is' postoperative month and differences were not statistically different from the preoperative period. None of the sleep parameters in the 2nd postoperative month differed from the values obtained in the preoperative period. Conclusion The cause of sleeplessness after CABG surgery may be temporary deterioration of circulation in the centers of the brain stem and hypothalamus that control sleep and awakening. Improvement of the circulation in these centers a few months after the operation helps to regain sleep control, and thus sleep disturbances disappear.Item An uncommon cause of pulsation on the left side of the thorax Case reportSirin, BH; Iskesen, I; Kurdal, ATA 70 years old man affected by clinical findings of congestive heart failure eight months after aneurysmectomy of a true left ventricular aneurysm, presented with actual pseudoaneurysm of the left ventricle. There was a 5 x 5 cm soft tissue mass on the left side of the chest, synchronously pulsating with heart beating. The repair was performed with the aid of cardiopulmonary bypass. Myocardial tissues were approximated and closed by using two Teflon stripes. BioGlue was applied on the sutures and between the stripes. Although there is a significantly high mortality of the pseudoaneurysm cases their repair can and should be performed in an urgent procedure.Item Left ventricle perforation and pseudoaneurysm with an unusual presentation of a patient with stomachache. Case reportSirin, BH; Iskesen, I; Kurdal, ATA 49-year-old man admitted with a 3 weeks history of stomachache and without any cardiac symptoms and diagnosed as pseudoaneurysm of the left ventricle is reported. The repair was performed with the aid of cardiopulmonary bypass, defect was repaired with Gore-tex patch and myocardial tissues were approximated and closed by using two Teflon stripes. BioGlue was applied on the sutures and between the stripes. We report this unusual case because rarity and high clinical index of suspicion is needed to make correct diagnosis in such patients. Although there is a significantly high mortality of the pseudoaneurysm cases their repair can and should be performed as an urgent procedure.Item The effect of piroxicam on the prevention of postoperative retrosternal and pericardial adhesionsIskesen, I; Aksoy, O; Cerrahoglu, M; Sirin, HBackground - The presence of adhesions after heart operations increases the risk of life-threatening damage to the heart and extracardiac grafts. Infections, tissue injury and inflammations are suspected aetiologic agents. The main purpose of our study is to evaluate the effect of an antiinflammatory agent piroxicam on the formation of retrosternal and pericardial adhesions in a rabbit model. Material and methods - 23 of forty-two New Zealand white rabbits were labelled as group P (piroxicam group) and the others as group C (n = 19, control group). All animals were subjected to median sternotomy and abrasion was applied to the epicardium and pericardium. Piroxicam was given only to group P animals 10 mg/kg/day intramuscularly on the day of operation and twice daily for 2 days postoperatively. All animals were sacrificed on the 10(th) postoperative day. After cardiectomy, the pericardium was totally excised; retrosternal and pericardial adhesions were evaluated and scored. t-PA (tissue plasminogen activator), PAI-I (plasminogen activator inhibitor-I) levels and pericardial tissue myeloperoxidase activities were measured. Results - More severe retrosternal and pericardial adhesions were observed in the control group (P < 0.05). Mean levels of t-PA were higher in the study group than in the control group (P < 0.05). Mean levels of PAI-I were lower in the study group (P < 0.05). Hence pericardial fibrinolytic capacity was significantly higher in the piroxicam group than in the control group. Myeloperoxidase activities in the pericardium were significantly lower in the study group than in the control group (P < 0.05). Conclusion - The use of piroxicam in the perioperative period prevents inflammation, preserves the fibrinolytic capacity of the pericardium and decreases the postoperative pericardial and retrosternal adhesions.Item Sleep disturbances after cardiac surgery with or without elevated S100B levelsIskesen, I; Kurdal, AT; Yilmaz, H; Cerrahoglu, M; Sirin, BHObjective - The aim of the study was to investigate sleep disturbances of cardiac surgery patients with or without elevated S100B levels. Methods and results - Twenty-two patients with serum S100B > 0.3 mu g/l (study group) 12 hours after cardiac surgery with cardiopulmonary bypass and 23 patients with serum S100B < 0.3 (control group) were investigated in a prospective study. They were evaluated with the use of objective sleep tests. Cardiopulmonary bypass has negatively affected the sleep characteristics in the postoperative period for both groups. Maintenance wakefulness test, total sleep time, total activity score and sleep efficiency scores were significantly shorter in the study group in the postoperative period. Sleep latency, percentage of wakefulness after sleep onset, daytime napping episodes and total nap duration in the same period were significantly higher than in the control group. Conclusion - Cardiac surgery affects a patient's sleep characteristics. Patients with elevated S100B values have more sleep disturbances after cardiac surgery than patients with normal S100B values.Item Objective and subjective characteristics of sleep artery bypass graft surgery in the early period: A prospective Study with healthy subjectsYilmaz, H; Iskesen, IBackground. The purpose of this study was to investigate changes in sleep characteristics by examining both subjective tests and objective parameters such as actigraphic sleep analysis in patients who underwent coronary artery bypass graft surgery (CABG). Patients and Methods. Forty-five patients who underwent CABG operations and did not have any sleep disturbance were examined. They were evaluated by subjective and objective sleep parameters at the beginning of the examination and on the fifth postoperative day. Forty healthy subjects who did not undergo the operation were also evaluated. Results. The Pittsburgh Index and Epworth values in the postoperative group were significantly higher, but Maintenance of Wakefulness Test lengths were significantly shorter than in the preoperative and control groups. Sleep latency, napping episodes, total napping periods, and fragmentation index values of the postoperative group were significantly higher, but sleep efficiency values were significantly lower than in the preoperative and control groups. Conclusion. The cause of sleeplessness after CABG surgery may be the temporary deterioration of circulation in the centers of the brain stem and hypothalamus, which control sleep and awakening. It can be proposed that the improvement of the circulation in these centers a couple of months after the operation help to regain sleep control, and thus sleep disturbances disappear.Item Congenitally corrected transposition of the great arteries plus dextrocardia operated with an unusual operative techniqueSirin, BH; Kurdal, AT; Iskesen, IWe describe a case of congenitally corrected transposition of the great arteries plus dextrocardia and normal anatomical abdominal viscera. Systemic (tricuspid) valve replacement was performed due to moderately severe valve regurgitation. An unusual operative technique Was used because of the patient's rare morphology. On cardipopulmonary bypass, the systemic valve was approached via a left atriotomy anterior to the left pulmonary veins, whereby the surgeon was positioned on the patient's left side. As the surgeon had excellent exposure from the opposite side of the table, he was able to perforin a tricuspid valve replacement through the left atrium. Our aim is to share our limited experience of such cardiac morphology, which may oblige the Surgeon to be positioned on the left side of the table to perform systemic valve surgery.Item Is Genetic Screening Necessary for Determining the Possibility of Venous Thromboembolism in Cancer Patients?Onur, E; Kurdal, AT; Tugrul, B; Iskesen, I; Dundar, P; Taneli, F; Ulman, C; Var, AObjective: To determine the risk of an association with some genetic polymorphisms involved in venous thromboembolism (VTE) gene variations (FVL, FV H1299R, FII G20210A, MTHFR C677T, MTHFR A1298C, PAI-1 4G/5G, beta-fibrinogen -455 G -> A, FXIII Val34Leu and GpIIIa HPA-1a) in cancer patients. Subjects and Methods: Among 78 cancer patients, 28 who had proven first episode of VTE were selected as the patient group, with 50 control samples selected from age-, sex-and body mass index-matched healthy volunteers (healthy group). The differences in frequency of genetic polymorphisms were found to be statistically insignificant between these two groups. Results: Logistic regression analysis after adjustment for age, sex, smoking and hypertension showed no difference. The screened mutations of these genes were not significantly associated with VTE risk. Conclusion: There is no possible benefit from genetic screening tests regarding VTE in cancer patients. Copyright (C) 2011 S. Karger AG, BaselItem Does remote ischemic preconditioning affect the systemic inflammatory response by modulating presepsin levels?Bayram, B; Senarslan, DA; Sengel, A; Ozturk, T; Onur, E; Iskesen, IObjective: We investigated the effect of Remote Ischemic Preconditioning (RIPC) on the inflammatory response during CPB by means of serum presepsin levels at preoperative and postoperative 1st and 24th h. Methods: In this prospective, randomized, cross-sectional study we included 81 patients undergoing coronary artery bypass graft surgery with cardiopulmonary bypass (CPB). Patients were randomized and RIPC was applied to 40 patients in the study group before anesthesia. The remaining 41 patients were determined as the control group. The relationships between RIPC and factors such as presepsin, C-reactive protein (CRP), and leukocyte levels were investigated. Results: There was no significant difference between the groups in postoperative leukocyte and CRP values (p = 0.52, p = 0.13, respectively). When the preoperative and postoperative first hour presepsin values of the patients were compared, no significant difference was found in the control group (p = 0.17), but a significant difference was found in the study group (p < 0.05). When the presepsin values were compared between the groups, a significant difference was found only in the postoperative first hour value (p < 0.05). Conclusions: It was observed that RIPC application caused to increase the presepsin levels in the postoperative first hour significantly in the study group (p < 0.05).Item eComment: Risks of combination techniqueKurdal, AT; Iskesen, IItem Trimetazidine May Protect the Myocardium during Cardiac SurgeryIskesen, I; Kurdal, AT; Eserdag, M; Cerrahoglu, M; Sirin, BHBackground: Trimetazidine is an anti-ischemic agent with cardioprotective effects. The purpose of this double-blind, controlled, prospective randomized study was to investigate the possible effects of the preoperative use of trimetazidine on the biochemical markers of myocardial injury during open heart surgery and to determine if it has any myocardial protective effects. Methods: Thirty patients undergoing coronary artery bypass grafting surgery, received either trimetazidine (study group, n = 15) or not (control group, n = 15). Pretreatment began 2 weeks before the operation with trimetazidine (60 mg/day orally), and the control group received no medication. We measured the levels of serum creatine kinase (CK), CK isoenzyme MB (CK-MB), myoglobin, and troponin T in venous blood samples obtained before and after the operation to evaluate the effect of this drug against myocardial damage. We also took serial blood samples from the radial artery and the coronary sinus before the institution of cardiopulmonary bypass (CPB) and at 2 and 15 minutes after the removal of the cross-clamp to measure lactate levels and calculate the lactate extraction of the myocardium. Results: Postoperative levels of myoglobin, troponin T, CK, and CK-MB were significantly lower in the trimetazidine group than in the control group (P < .05). There was also a significant difference in the values for the lactate extraction calculation between the groups at minute 2 after the removal of the cross-clamp (P < .05). Conclusion: We conclude that pretreatment with trimetazidine has some beneficial effects in protecting the myocardium and decreasing myocardial injury during the cardioplegic arrest period in open heart surgery without affecting postoperative hemodynamics.